Provider Demographics
NPI:1689848202
Name:MARK SCHLOTHAUER, D.D.S. P.C.
Entity Type:Organization
Organization Name:MARK SCHLOTHAUER, D.D.S. P.C.
Other - Org Name:GERING DENTAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:SCHLOTHAUER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:308-436-3196
Mailing Address - Street 1:1270 SAGE ST
Mailing Address - Street 2:
Mailing Address - City:GERING
Mailing Address - State:NE
Mailing Address - Zip Code:69341-3228
Mailing Address - Country:US
Mailing Address - Phone:308-436-3196
Mailing Address - Fax:308-436-3197
Practice Address - Street 1:1270 SAGE ST
Practice Address - Street 2:
Practice Address - City:GERING
Practice Address - State:NE
Practice Address - Zip Code:69341-3228
Practice Address - Country:US
Practice Address - Phone:308-436-3196
Practice Address - Fax:308-436-3197
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-15
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE6371122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025590000Medicaid